Association between obstructive sleep apnea and lipid metabolism during REM and NREM sleep

Huajun Xu; Yunyan Xia; Xinyi Li; Yingjun Qian; Jianyin Zou; Fang Fang; Hongliang Yi; Hongmin Wu; Jian Guan; Shankai Yin

doi:10.5664/jcsm.8242

Association between obstructive sleep apnea and lipid metabolism during REM and NREM sleep

J Clin Sleep Med. 2020 Apr 15;16(4):475-482. doi: 10.5664/jcsm.8242.

Authors

Huajun Xu^{1

2

3

4}, Yunyan Xia^{1

2

3

5

4}, Xinyi Li^{1

2

3}, Yingjun Qian^{1

2

3}, Jianyin Zou^{1

2

3}, Fang Fang⁶, Hongliang Yi^{1

2

3}, Hongmin Wu^{1

2}, Jian Guan^{1

2

3}, Shankai Yin^{1

2

3}

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
² Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.
³ Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
⁴ Contributed equally.
⁵ Department of Otorhinolaryngology Head & Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁶ Nursing Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Abstract

Study objectives: Obstructive sleep apnea (OSA) is thought to be associated with dyslipidemia. However, differences concerning dyslipidemia during rapid eye movement (REM) and non-REM (NREM) sleep have yet to be determined. This study was designed to explore the association between lipid profiles and OSA during REM or NREM sleep.

Methods: This is a clinical cohort. A total of 2,619 participants with at least 30 minutes of REM sleep were included. Sleep variables and fasting lipid profiles [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo)A-I, apoB, apoE, and lipoprotein(a) (Lp(a))] were obtained from each participant. Apnea-hypopnea indices in REM and NREM sleep (AHI_REM and AHI_NREM, respectively) were recorded. Linear regression analysis was used to assess the associations of AHI_REM and AHI_NREM with lipid profiles.

Results: When stratified by the AHI_REM severity of OSA, all demographics, clinical variables, and sleep parameters differed between the groups except for apoA-I. In fully-adjusted multivariate linear regression models, AHI_REM was independently associated with increasing levels of TG, HDL-C, and apoE (P = .04, P = .01 and P = .01, respectively). AHI_NREM was independently associated with increasing levels of TC, TG, LDL, and apoB, and lower level of HDL-C (all P < .05). In sensitivity analyses by only exploring associations in patients who had an AHI_NREM or AHI_REM < 5 events/h in separate regression models, AHI_REM was not associated with all-lipid profile in almost all adjusted models (all P > .05), whereas AHI_NREM was associated with elevated TC, LDL-C, and apoB (P = .03, P = .01 and P = .01, respectively).

Conclusions: AHI_NREM was independently associated with the greatest alterations in serum lipids, including TC, LDL-C, and apoB.

Keywords: dyslipidemia; lipid profile; obstructive sleep apnea; rapid eye movement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Lipid Metabolism
Sleep
Sleep Apnea, Obstructive* / complications
Sleep, REM
Sleep, Slow-Wave*